hospital referral and analgesia

Question 1

hospital proceudres upon admission

Answer 1

patient is checked in
history, records, labs reviewed
IV started
dilation check
pain managment options

Question 2

systemic analgesia- narcotic agonists

Answer 2

demerol
fentanyl
morphine sulfate

Question 3

narcotic agonists effects

Answer 3

Quick onset (within a few minutes); short term relief
Not effective at removing pain; makes woman care less about the pain
Decrease fetal heart tone variability; starts to recover around 30 minutes after dose
Dose related neonatal respiratory depression immediately before delivery. May require naloxone
Potential for neonatal toxicity

Question 4

systemic analgesia- narcotic agonist-antagonists

Answer 4

stadol

nubain

Question 5

agonist-antagonists effects

Answer 5

Do not provide better analgesia than narcotic agonists
Quick onset; short term relief
Lower rate of newborn respiratory depression
Increased incidence of sinusoidal fetal heart pattern
Potential for neonatal toxicity

Question 6

3 types of regional analgesia

Answer 6

Epidural (slower onset, segmental block, minimal motor block, continuous infusion)
Spinal (rapid onset, dense block, dense motor block, short action)
Combination epidural/spinal

Question 7

advantages of epidurals

Answer 7

Provides pain relief in first and second stages of labor
Provides anesthesia for interventions, including episiotomy, instrumental delivery, perineal repair
Allows extension of anesthesia for cesarean delivery
Avoids opioid-induced maternal and neonatal respiratory depression from i.v. opioids
Helps control BP of women with preeclampsia

Question 8

adverse effects of epidurals

Answer 8

hypotension
fever
post-dural puncture headache
transient painful sensations in buttocks or lower extremities
transient fetal heart rate decrease
pruritis
inadequate pain relief
prolonged length of labor
increased instrumentation
increased use of oxytocin

Question 9

contraindications for epidurals

Answer 9

Refractory maternal hypotension
Maternal coagulopathy or anticoagulant therapy
Untreated maternal bacteremia
Skin infection over site of needle placement
Increased intracranial pressure caused by a mass lesion
Actual or anticipated serious maternal hemorrhage